Everything You Need To Know About Endometriosis
Medikoe Health Expert
Koramangala, bengaluru, karnataka, india, Bengaluru Feb 9, 2017
Endometriosis is a painful condition in females in which a tissue that normally lines the inside of the uterus or womb, grows outside of it (endometrial implant). The fabric can implant in places like the fallopian tube, ovaries, bowels and pelvis. This tissue bleeds with every menstrual cycle, which can cause inflammation pain and infertility. Doctors often confirm endometriosis with a surgery.
Women experiencing pain during periods, excessive bleeding during menses, pain during intercourse, inability to conceive may be suffering from some or the other stage of endometriosis. Often women with severe endometriosis are asymptomatic. Therefore, the pain of endometriosis is not related to its severity. The condition is often mistaken for other ovarian cysts, pelvic inflammatory disease delaying its diagnosis.
Causes of Endometriosis
The endometrial implant that is present elsewhere outside the uterus also grows and bleeds every month like normal menstruation, resulting in the collection of menstrual blood in the ovary, pelvis etc. This collection causes pain. The blood collected there causes irritation of surrounding tissue, eventually developing scar tissue and thin adhesions which causes organs to bind with each other.
Infertility and pain are significant causes of concern. Fortunately, effective treatments are available. Many theories have been proposed as causes of endometriosis - like metaplastic changes, reverse flow of menstrual blood, immunological, inflammatory and genetic causes.
Even though the exact cause of endometriosis is not specified still, some of the possible explanations include-
Transformation of peritoneal cells
Embryonic cell transformation
Surgical scar implantation
Endometrial cell transport
Immune system disorder
Symptoms of Endometriosis
The symptoms of the condition may vary from person to person. Some women experience mild symptoms, whereas others can have moderate to severe symptoms. The symptoms of endometriosis can be quite similar to the symptoms of some other conditions like ovarian cysts and pelvic inflammatory disease. The severity of the pain you’re bearing doesn't indicate the stage or degree of the condition.
There are a number of symptoms like-
Painful periods (dysmenorrhea)
Pain with intercourse
Pain with bowel movements or urination
Other signs and symptoms like fatigue, diarrhoea, constipation, etc.
Diagnosis of Endometriosis
The symptoms of endometriosis can be quite similar to the symptoms of some other conditions like ovarian cysts and pelvic inflammatory disease. Treating your pain requires an accurate diagnosis.
Endometriosis is diagnosed by doctors using Ultrasonography where ovarian endometriosis can be easily visualized. Doctors often confirm endometriosis with a surgery. They make a small incision in the abdomen and insert a small tube with a light and camera to view the pelvic region. Seeing the Endometrial implants and scarring can help them categorize endometriosis into stages
Definitive diagnosis and severity of a patient suffering from the condition can be ascertained by direct and thorough visualization of pelvic organs by laparoscopy. A biopsy from the affected area proves endometriosis histologically. The advantage of laparoscopy is that certain treatment can also be carried out in the same sitting.
Stages of Endometriosis
The endometriosis at its first stage is "minimal."
The implants are small, few in number and shallow
But just because a woman has stage1 does not mean the pain is minimal.
The endometriosis at the second stage is "mild."
Doctors might find more and deeper implants.
The endometriosis at this stage is considered "moderate."
There are now many deep endometrial implants.
There may be an endometrial cyst on at least one ovary.
Doctors may also find thin bands of tissues, called "Filmy Adhesions," that bind organs together.
This is the final stage where the endometriosis is considered "severe."
In addition to many deep endometrial implants, there are large cysts on at least one ovary.
There are many dense adhesions throughout the pelvic region.
Treatment for Endometriosis
Treatment of Endometriosis depends on the patient's age, severity, and whether fertility is an issue or not. If the woman has already had children, treatment may be hormones, pain killers or surgical removal based on severity or the stage. Treatment of Endometriosis in infertile women is entirely different and should be done in the hands of a fertility specialist.
Complications of Endometriosis
The main complication faced by a woman suffering from endometriosis is impaired fertility. Approximately 40-50% of the women with the condition are infertile. This is due to poor egg quality, defective implantationdistorted tubo-ovarian anatomy which inhibits transport of eggs and sperm through the tube etc.
Women with initial stages of endometriosis may still be able to conceive naturally. Hence, it is advised not to postpone your pregnancy if you are diagnosed with endometriosis as the condition may even worsen with time.
Women with minimal-mild endometriosis as visualized by laparoscopy may conceive naturally but women with moderate to severe endometriosis, especially ovarian endometrioma of more than 3cm may require surgical excision before proceeding to assisted reproductive technologies.
Care should be taken not to excise normal ovarian tissue during the surgery as it may deplete or affect ovarian egg reserve drastically. For these women, IVF is the best modality of treatment as postponement of pregnancy by attempting to conceive naturally may worsen the disease.
Ovarian cancer does occur at higher than expected rates in those with endometriosis. But the overall lifetime risk of ovarian cancer is low, to begin with. Some studies suggest that endometriosis increases that risk, but it's still relatively low. Although rare, another type of cancer — endometriosis-associated adenocarcinoma — can develop later in life in those who have had endometriosis.
Risk factors for Endometriosis
there are several factors that place you at greater risk of developing endometriosis. Some of those factors are-
Never giving birth
Low body mass index
Reproductive tract abnormalities
Going through menopause at an older age
One or more close relatives with endometriosis
Heavy menstrual periods that last longer than usual
Therefore, if you are suffering from symptoms suggestive of endometriosis or a proven case of the condition trying to conceive, or with repeated fertility treatment failures then it is suggested that you go to an IVF clinic for treatment or see a doctor.
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